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Rehabilitation Process

Rene Chavez received a unilateral, below elbow transplant at Duke University. He is shown doing strength exercises during occupational therapy 3 months after his transplant surgery. (Shawn Rocco & Duke Health)

To Regain Hand Functions, Hand/Arm Transplant Recipients Must Go Through a Long Process of Rehabilitation:

Rehabilitation experiences will vary widely in content and timeline.¹
The rehabilitation team begins working with the recipient within 2 to 7 days after the surgery, and the recipient continues hand therapy for anywhere from months to a few years after the transplant.¹
The duration of rehabilitation depends on whether the amputation and transplant are below or above the elbow because this affects how much distance the nerves must regrow.
Clinical and functional outcomes depend strongly on the recipient’s active participation in rehabilitation, so recipients should commit themselves fully during this time.¹

“

“It’s very different having to relearn, right? Because you learned with the prosthetic, and you got that down, and now you’ve got these arms back and you kind of got to relearn how to use them” 

-  John Peck, a 31-year-old retired marine who received a double arm transplant

Source: CBS News: Marine vet hopes to fulfill "lifelong dream" after double arm transplant

Mr. Pollock, a bilateral, upper limb transplant recipient (11 ½ years after transplantation), talks about his experiences with rehabilitation and how his therapy has changed over time.

Rehabilitation Timeline

The timeline of recovery differs for each recipient. The timeline below illustrates a rehabilitation course for a below-elbow hand/arm transplant recipient.²

    Time Post
Hand Transplant
    Rehabilitation Goals
  
    0-3 Weeks

    Static splinting, positioning to control edema, active assisted motion of shoulder and elbow, and passive mobilization of wrist and hand from 2 weeks on.
  
    3-6 Weeks

    Continued static splinting with modification, scar management and compressive dressings, progressive flexion/extension of wrist starting at 4 weeks, active assisted flexion/extension of fingers starting at 5 weeks.
  
    6-8 Weeks

    Continued active movement of wrist and fingers, gripping exercises, use of resting splint at night and for periods during the day, possible introduction of a static wrist splint with fingers free.
  
    8-12 Weeks

    Tendon gliding exercise, focus on flexor-extensor balance, electrotherapy during the eighth week to strengthen extrinsic muscles of forearm.
  
    3-6 Months

    Wrist stability and function, integration of transplanted hand into daily activities using aids as necessary.
  
    6-12 Months
    Focus on functional deficits and patient-specific needs.
  
    2 Years
    Therapy intensity is decreased. Focus on upper extremity positioning, strengthening the muscles in the hand and fingers, and maintaining and reestablishing therapy goals for the patient to work on independently.
  
    3 Years
    Strengthening.

Time Post Hand Transplant	Rehabilitation Goals
0-3 Weeks	Static splinting, positioning to control edema, active assisted motion of shoulder and elbow, and passive mobilization of wrist and hand from 2 weeks on.
3-6 Weeks	Continued static splinting with modification, scar management and compressive dressings, progressive flexion/extension of wrist starting at 4 weeks, active assisted flexion/extension of fingers starting at 5 weeks.
6-8 Weeks	Continued active movement of wrist and fingers, gripping exercises, use of resting splint at night and for periods during the day, possible introduction of a static wrist splint with fingers free.
8-12 Weeks	Tendon gliding exercise, focus on flexor-extensor balance, electrotherapy during the eighth week to strengthen extrinsic muscles of forearm.
3-6 Months	Wrist stability and function, integration of transplanted hand into daily activities using aids as necessary.
6-12 Months	Focus on functional deficits and patient-specific needs.
2 Years	Therapy intensity is decreased. Focus on upper extremity positioning, strengthening the muscles in the hand and fingers, and maintaining and reestablishing therapy goals for the patient to work on independently.
3 Years	Strengthening.

Jonathan Koch, 51, lost his hand after contracting an illness. He holds up his hand six weeks after having transplant surgery. (Reed Hutchinson/UCLA)

A hand therapist is testing the grip of the transplanted hand. (Reed Hutchinson/UCLA)

Jonathan Koch gets ready to catch a ball with his transplanted hand. (Reed Hutchinson/UCLA)

Jonathan Koch and his hand therapist work on his transplanted hand. (Reed Hutchinson/UCLA)

“

“Nearly 16 months after Jeff Kepner’s surgery… he showed far less progress: He had trouble writing with a marker, picking up small balls, and doing tasks that… other transplant patients had accomplished just weeks out.” 

- In reference to Jeff Kepner, a 57-year-old who received a double hand transplant in 2009

Source: The Devastating Allure of Medical Miracles | WIRED

Click Below for More Videos

Videos of Health Care Professionals

Joe Butkus, UE Transplant Occupational Therapist, describes the rehabilitation process for hand/arm transplantation.

Dr. Scott Tintle, Chief of Hand Surgery, talks about the rehabilitation process for hand/arm transplant recipients at Walter Reed National Military Medical Center.

Angie Duckworth, Transplant Social Worker, talks about how patients stay in close contact with their transplant team after surgery.

Joe Butkus, UE Transplant Occupational Therapist, describes a patient's rehabilitation process after transplantation.

Dr. Dumanian, Chief of Plastic Surgery, describes the commitment necessary for post-operative therapy.

Videos of Hand/Arm Transplant Recipients and People with Limb Loss

Mr. Lund, bilateral upper limb transplant recipient (5 years after transplantation), talks about how his transplants have affected his life.

Mr. Lund, bilateral upper limb transplant recipient (5 years after transplantation), talks about how often he frequents hospitals for various appointments.

Mr. White, with unilateral, below-elbow limb loss (6 years after amputation), talks about questions he has had about the hand/arm transplant healing process.

Mr. Lund, bilateral upper limb transplant recipient (5 years after transplantation), explains his rehabilitation experience.

Mr. Lund, bilateral upper limb transplant recipient (5 years after transplantation), explains how he uses resting hand splints.

Mr. Lund, bilateral upper limb transplant recipient (5 years after transplantation), talks about life with hand/arm transplants.

Mr. Pollock, a bilateral, upper limb transplant recipient (11 ½ years after transplantation), talks about his earlier experiences during recovery after his hand/arm transplants.

References

Sources

Kubiak CA, Etra JW, Brandacher G, et al. Prosthetic Rehabilitation and Vascularized Composite Allotransplantation Following Upper Limb Loss. Plast Reconstr Surg. 2019;143(6):1688-1701.
Urso G, Stroppa L, Barchitta T, et al. Return of Sensibility and Motor Recovery of Extrinsic and Intrinsic Muscles. In: Lanzetta M, Dubernard JM eds.: Hand Transplantation. Italy: Springer-Verlag, 2007:279-290.

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